Systemic and Topical Treatment of Hand Eczema: Less Well-Established Agents

  • Richard R. WinkelmannEmail author
  • Ali Alikhan


Despite advances in the treatment of refractory chronic hand eczema, many patients remain burdened with recalcitrant disease. Patients with limited therapeutic options may use topical bexarotene, systemic steroids, ranitidine, vitamin E, azathioprine, disulfiram, disodium cromoglycate, zinc sulfate, iron, or biologics to achieve control of symptoms. Evidence for the use of these atypical agents is only supported by smaller studies, anecdotal evidence, or single case reports.


Allergic Contact Dermatitis Zinc Sulfate Hand Eczema Betamethasone Valerate Atypical Agent 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Mangelsdorf DJ, Evans RM. The RXR heterodimers and orphan receptors. Cell. 1995;83:841–50.PubMedCrossRefGoogle Scholar
  2. 2.
    Cheng S, Kupper T. A new rexinoid for cutaneous T-cell lymphoma. Arch Dermatol. 2001;137:649–52.PubMedGoogle Scholar
  3. 3.
    Hanifin JM, Stevens V, Sheth P, Breneman D. Novel treatment of chronic severe hand dermatitis with bexarotene gel. Br J Dermatol. 2004;150(3):545–53.PubMedCrossRefGoogle Scholar
  4. 4.
    Alavi A, Skotnicki S, Sussman G, Sibbald RG. Diagnosis and treatment of hand dermatitis. Adv Skin Wound Care. 2012;8:381–2.Google Scholar
  5. 5.
    Warshaw E, Lee G, Storrs FJ. Hand dermatitis: a review of clinical features, therapeutic options, and long-term outcomes. Am J Contact Dermatol. 2003;14(3):119–37.Google Scholar
  6. 6.
    Nesbitt Jr LT. Minimizing complications from systemic glucocorticoid use. Dermatol Clin. 1995;13:925–39.PubMedGoogle Scholar
  7. 7.
    Nielsen HJ, Nielsen H, Georgsen J. Ranitidine for improvement of treatment resistant psoriasis: mechanisms and speculations. Dan Med Bull. 1991;38:478–80.PubMedGoogle Scholar
  8. 8.
    Veien NK, Kaaber K, Larsen PO, Nielsen AO, Thestrup-Pedersen K. Ranitidine treatment of hand eczema in patients with atopic dermatitis: a double blind placebo controlled trial. J Am Acad Dermatol. 1995;32:1056–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Olson PE, Torp EC, Mahon RT, Weiss PJ, Wallace MR. Oral vitamin E for refractory hand dermatitis. Lancet. 1994;343(8898):672–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Kappus H, Diplock AT. Tolerance and safety of vitamin E: a toxicological position report. Free Radic Biol Med. 1992;13:55–74.PubMedCrossRefGoogle Scholar
  11. 11.
    Lakshmi C, Srinivas CR. Parthenium the terminator: an update. Indian Dermatol Online J. 2011;3:89–100.CrossRefGoogle Scholar
  12. 12.
    Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I. Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, cross-over trial. Br J Dermatol. 2002;147:324–30.PubMedCrossRefGoogle Scholar
  13. 13.
    Pearce VJ, Mortimer PS. Hand dermatitis and lymphoedema. Br J Dermatol. 2009;161(1):177–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Meggitt SJ, Reynolds NJ. Azathioprine for atopic dermatitis. Clin Exp Dermatol. 2001;26:369–75.PubMedCrossRefGoogle Scholar
  15. 15.
    Christensen OB, Moller H. Nickel allergy and hand eczema. Contact Dermatitis. 1975;1:136–42.PubMedCrossRefGoogle Scholar
  16. 16.
    Sharma AD. Disulfiram and low nickel diet in the management of hand eczema: a clinical study. Indian J Dermatol Venereol Leprol. 2006;72:113–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Kaaber K, Menne T, Tjell JC. Low nickel diet in the treatment of patients with chronic nickel dermatitis. Br J Dermatol. 1978;98:197.PubMedCrossRefGoogle Scholar
  18. 18.
    Kaaber K, Menne T, Tjell JC, Veien N. Antabuse treatment of nickel dermatitis. Chelation- a new principal in the treatment of nickel dermatitis. Contact Dermatitis. 1979;5:221–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Kaaber K, Menne T, Veien N, Hougaard P. Treatment of nickel dermatitis with Antabuse; a double blind study. Contact Dermatitis. 1983;9:297–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Christensen OB, Kristensen M. Treatment with disulfiram in chronic nickel hand dermatitis. Contact Dermatitis. 1982;8:59–63.PubMedCrossRefGoogle Scholar
  21. 21.
    Pigatto PD, Gibelli E, Fumagalli M, Bigardi A, Morelli M, Altomare GF. Disodium cromoglycate versus diet in the treatment and prevention of nickel-positive pompholyx. Contact Dermatitis. 1990;22:27–31.PubMedCrossRefGoogle Scholar
  22. 22.
    Santucci B, Cristaudo A, Mehraban M, Valenzano C, Camera E, Picardo M. ZnSO4 treatment of NiSO4-positive patients. Contact Dermatitis. 1999;40:281–2.PubMedCrossRefGoogle Scholar
  23. 23.
    Weissmann K, Menne T. Nickel allergy and drug interaction. In: Maibach HI, Menne T, editors. Nickel and the skin: immunology and toxicology. 1st ed. Boca Raton: CRC Press; 1989.Google Scholar
  24. 24.
    Sharma AD. Iron therapy in hand eczema: a new approach for management. Indian J Dermatol. 2011;56(3):295–9.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Tallkvist J, Bowlus CL, Lonnerdal B. Effect of iron treatment on nickel absorption and gene expression of the divalent metal transporter (DMT1) by human intestinal Caco-2 cells. Pharmacol Toxicol. 2003;92:121–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Leonardi CL, Powers JL, Matheson RT, Goffe BS, Zitnik R, Wang A, Gottlieb AB, Etanercept Psoriasis Study Group. Etanercept as monotherapy in patients with psoriasis. N Engl J Med. 2003;349(21):2014–22.PubMedCrossRefGoogle Scholar
  27. 27.
    Ogden S, Clayton TH, Goodfield MJ. Recalcitrant hand pompholyx: variable response to etanercept. Clin Exp Dermatol. 2006;31(1):145–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Ellis CN, Krueger GG, Alefacept Clinical Study Group. Treatment of chronic plaque psoriasis by selective targeting of memory effector T lymphocytes. N Engl J Med. 2001;345(4):248–55.PubMedCrossRefGoogle Scholar
  29. 29.
    Gribetz GH, Blum R, Brady C, Cohen S, Lebwohi M. An extended 16-week course of alefacept in the treatment of chronic plaque psoriasis. J Am Acad Dermatol. 2005;53:73–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Moed H, Boosma DM, Stoof TJ, von Blomberg BM, Bruynzeel DP, Scheper RJ, et al. Nickel-responding T cells are CD4+, CLA+, CD45RO45+ and express chemokine receptors CXCR3, CCR4, and CCRIO. Br J Dermalol. 2004;151:32–41.CrossRefGoogle Scholar
  31. 31.
    Aronson PJ, Yeung-Yue KA. Treatment of hand dermatitis with alefacept. Dermatitis. 2008;19(3):161–2.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.InternO’Bleness Memorial HospitalAthensUSA
  2. 2.Department of DermatologyMayo ClinicRochesterUSA

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